Provider Demographics
NPI:1649726431
Name:WHEELER, CARLOS CHARLES I
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:CHARLES
Last Name:WHEELER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 HANSBROUGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1718
Mailing Address - Country:US
Mailing Address - Phone:504-508-0707
Mailing Address - Fax:
Practice Address - Street 1:7300 HANSBROUGH ST
Practice Address - Street 2:7300 HANSBROUGH ST
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127
Practice Address - Country:US
Practice Address - Phone:504-508-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006627152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health